Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis
Authors: Marcello Di Martino, Benedetto Ielpo, Francesco Pata, Gianluca Pellino, Salomone Di Saverio, Fausto Catena, Belinda De Simone, Federico Coccolini, Massimo Sartelli, Dimitrios Damaskos, Damian Mole, Valentina Murzi, Ari Leppaniemi, Adolfo Pisanu, Mauro Podda, Chiara Gerardi, Francesco Virdis, Daniela Pacella, Kumar Jayant, Ferdinando Agresta, Cristiana Riboni, Yoram Kluger, Martin de Santibañes, Juliana Di Menno Stavron, Oscar Mazza, José I Valenzuela, Diana AP Pachajoa, Fernando A Alvarez, Julian E Liaño, Justin Gundara, Joan Tefay, Kamel Alawadhi, Abdulrahman Alshaikh, Layla Hasan, Carlos A Gomes, Felipe C Gomes, Gustavo P Fraga, Thiago RA Calderan, Elcio S Hirano, Dragomir Dardanov, Alexander Julianov, Azize Saroglu, Boyko Atanasov, Nikolay Belev, Nikola Kovachev, Rashid Lui, Shannon M Chan, Hon-Ting Lok, Diego Salcedo, Diana Robayo, Maria A Triviño, Jan Manak, Saaz Sahani, Jorann de Araujo, Ananya Sethi, Ahmed Awad, Merihan Elbadawy, Ahmed Farid, Asmaa Hanafy, Ahmed Nafea, Sherief Ghozy, Alzhraa Salah–Abbas, Wafaa Abdelsalam, Sameh Emile, Ahmed Elfallal, Hossam Elfeki, Hosam Elghadban, Ashraf Shoma, Mohamed Shetiwy, Mohamed Elbahnasawy, Salem Mohamed, Emad F Hamed, Usama A Khalil, Elie Chouillard, Andrew Gumbs, Andréa Police, Andrea Mabilia, Zaza Demetrashvili, Kakhi Khutsishvili, Anano Tvaladze, Orestis Ioannidis, Elissavet Anestiadou, Lydia Loutzidou, Argyrios Ioannidis, Konstantinis Konstantinidis, Sofia Konstantinidou, Dimitrios Manatakis, Vasileios Acheimastos, Nikolaos Tasis, Nikolaos Michalopoulos, Panagiotis Kokoropoulos, Maria Papadoliopoulou, Maria Sotiropoulou, Stylianos Kapiris, Panagiotis Metaxas, Ioannis Tsouknidas, Despoina Kefili, George Petrakis, Eirini Synekidou, Konstantinos Dakis, Eirini Alexandridou, Aristeidis Papadopoulos, Christos Chouliaras, Odysseas Mouzakis, Francesk Mulita, Ioannis Maroulis, Michail Vailas, Tania Triantafyllou, Dimitrios Theodorou, Eftychios Lostoridis, Eleni A Nagorni, Paraskevi Tourountzi, Efstratia Baili, Alexandros Charalabopoulos, Theodore Liakakos, Dimitrios Schizas, Alexandros Kozadinos, Athanasios Syllaios, Nikolaos Machairas, Stylianos Kykalos, Paraskevas Stamopoulos, Spiros Delis, Christos Farazi-Chongouki, Evangelos Kalaitzakis, Miltiadis Giannarakis, Konstantinos Lasithiotakis, Giorgia Petra, Sergio Ralon, Amit Gupta, Noushif Medappil, Vijayanand Muthukrishnan, Jubin Kamar, Lovenish Bains, Pawan Lal, Rajendra Agarwal, Matteo Magnoli, Paolo Aonzo, Alberto Serventi, Antonio Giuliani, Pierpaolo Di Lascio, Margherita Pinto, Carlo Bergamini, Andrea Bottari, Laura Fortuna, Jacopo Martellucci, Atea Cicako, Claudio Miglietta, Mario Morino, Daniele Delogu, Andrea Picchetto, Marco Assenza, Giancarlo D'Ambrosio, Giulio Argenio, Giovanna Ioia, Mariano F Armellino, Savino Occhionorelli, Domenico Lacavalla, Dario Andreotti, Davide Luppi, Massimiliano Casadei, Luca Di Donato, Farshad Manoochehri, Tiziana RL Marchese, William Sergi, Roberto Manca, Raimondo Murgia, Enrico Piras, Lorenzo Conti, Simone Gianazza, Andrea Rizzi, Edoardo Segalini, Marco Monti, Elena Liritano, Nicolò M Mariani, Enrico De Nicola, Giovanna Scifo, Giusto Pignata, Jacopo Andreuccetti, Francesco Fleres, Guglielmo Clarizia, Alessandro Spolini, Alan Biloslavo, Paola Germani, Manuela Mastronardi, Selene Bogoni, Silvia Palmisano, Nicolò De Manzini, Marco V Marino, Gaetano Poillucci, Gennaro Martines, Giuseppe Trigiante, Elpiniki Lagouvardou, Gabriele Anania, Cristina Bombardini, Dario Oppici, Tiziana Pilia, Valentina Murzi, Emanuela Gessa, Eleonora Locci, Umberto Bracale, Maria M Di Nuzzo, Roberto Peltrini, Luca Ansaloni, Francesco Salvetti, Jacopo Viganò, Gabriele Sganga, Valentina Bianchi, Pietro Fransvea, Tommaso Fontana, Giuliano Sarro, Vincenza P Dinuzzi, Luca Scaravilli, Mario V Papa, Elio Jovine, Giulia Ciabatti, Laura Mastrangelo, Matteo Rottoli, Claudio Ricci, Iris S Russo, Alberto Aiolfi, Davide Bona, Francesca Lombardo, Pasquale Cianci, Mariagrazia Sederino, Roberto Bini, Osvaldo Chiara, Stefano PB Cioffi, Alessio Giordano, Stefano Cantafio, Guido Coretti, Edelweiss Licitra, Grazia Savino, Sergio Grimaldi, Raffaele Porfidia, Elisabetta Moggia, Mauro Garino, Chiara Marafante, Antonio Pesce, Nicolò Fabbri, Carlo V Feo, Ester Marra, Carlo Nagliati, Marina Troian, Davide Drigo, Andrea Muratore, Riccardo Danna, Alessandra Murgese, Michele Crespi, Luca Ferrario, Claudio Guerci, Alice Frontali, Luca Ferrari, Francesco Favi, Erika Picariello, Alessia Rampini, Fabrizio D'Acapito, Giorgio Ercolani, Leonardo Solaini, Francesco Palmieri, Matteo Calì, Francesco Ferrara, Irnerio A Muttillo, Edoardo M Muttillo, Biagio Picardi, Raffaele Galleano, Ali Badran, Omar Ghazouani, Maurizio Cervellera, Gaetano Campanella, Gennaro Papa, Annamaria Di Bella, Gennaro Perrone, Gabriele L Petracca, Concetta Prioriello, Mario Giuffrida, Federico Cozzani, Matteo Rossini, Marco Inama, Giovanni Butturini, Gianluigi Moretto, Luca Morelli, Giulio Di Candio, Simone Guadagni, Enrico Cicuttin, Camilla Cremonini, Dario Tartaglia, Valerio Genovese, Massimo Chiarugi, Nicola Cillara, Alessandro Cannavera, Antonello Deserra, Arcangelo Picciariello, Vincenzo Papagni, Leonardo Vincenti, Giulia Bagaglini, Giuseppe Sica, Pierfrancesco Lapolla, Gioia Brachini, Andrea Mingoli, Dario Bono, Antonella Nicotera, Marcello Zago, Fabrizio Sammartano, Laura Benuzzi, Marco Stella, Stefano Rossi, Alessandra Cerioli, Caterina Puccioni, Stefano Olmi, Carolina Rubicondo, Matteo Uccelli, Andrea Balla, Anna Guida, Pasquale Lepiane, Diego Sasia, Giorgio Giraudo, Sara Salomone, Giuseppe Nigri, Elena Belloni, Alessandra Cossa, Francesco Lancellotti, Roberto Caronna, Piero Chirletti, Paolina Saullo, Raffaele Troiano, Felice Mucilli, Mirko Barone, Massimo Ippoliti, Michele Grande, Bruno Sensi, Leandro Siragusa, Monica Ortenzi, Andrea Santini, Gastone Veroux, Isidoro Di Carlo, Rossella Gioco, Massimiliano Veroux, Giuseppe Currò, Michele Ammendola, Iman Komaei, Giuseppe Navarra, Valeria Tonini, Lodovico Sartarelli, Samuele Vaccari, Marco Ceresoli, Stefano Perrone, Linda Roccamatisi, Paolo Millo, Riccardo Brachet-Contul, Elisa Ponte, Matteo Zuin, Giuseppe Portale, Alice S Tonello, Geri Fratini, Matteo Bianchini, Bruno Perotti, Emanuele Doria, Elia G Lunghi, Diego Visconti, Almu'atasim Khamees, Khayry Al-Shami, Sajeda Awadi, Hazim Ababneh, Mohammad MK Buwaitel, Mo'taz FN Naffa', Osama Aljaiuossi, Ahmad Samhouri, Hatem Sawalha, Ahmad R Yusoff, Mohd F Che Ani, Ida NA Fathil, Jih Huei, Ikhwan S Mohamad, Andee D Zakaria, Mohammad Z Ya'acob, Jose L Beristain-Hernandez, Alejandro Garcia-Meza, Rafael Sepulveda-Rodriguez, Edgard E Lozada Hernández, Camilo L Acuña Pinzón, Jefferson N Condoy, Francisco C Becerra García, Samuel Pimentel, Ibrahim U Garzali, Mohammad Sadik, Bushra Kadir, Jalpa Devi, Nandlal Seerani, Mohammad Sohail- Asghar, Ameer Afzal, Ali Akbar, Gustavo M Machain, Helmut Segovia Lohse, Herald Segovia Lohse, Darwin A Quispe-Cruz, Zamiara SL Cabrera, Gaby S Yamamoto Seto, José R Chiuyari, Jorge Ordemar, Martha Rodríguez, Abigail CC Orantia-Carlos, Margie A Quitoy, Maciej Walędziak, Andrzej Kwiatkowski, Maciej Mawlichanów, Tiago Correia de Sá, Mónica Rocha, Carlos Soares, Syed Muhammad Ali, Alexandru R Stoian, Andreea D Draghici, Valentin T Grigorean, Valentin Calu, Raluca B Radulescu, Narcis O Zarnescu, Radu V Costea, Eugenia C Zarnescu, Andrey Litvin, Mikhail Kurtenkov, George Gendrikson, Volovich Alla-Angelina, Arina Tsurbanova, Ayrat Kaldarov, Mahir Gachabayov, Abakar Abdullaev, Bojan Kovacevic, Milica Milentijevic, Milovan Karamarkovic, Arpád Panyko, Dusan Lesko, Jozef Radonak, Marek Soltes, Colin Noel, Haidar M Abdalah, Hytham KS Hamid, Raffaello Roesel, Alessandra Cristaudi, Alaa Hamdan, Kinan Abbas, Iyad Ali, Ali Kchaou, Ahmed Tlili, Arda Isik, Hüseyin Bayhan, Mehmet A Türkoğlu, Mustafa Y Uzunoglu, Ibrahim F Azamat, Nail Omarov, Derya S Uymaz, Fatih Altintoprak, Emrah Akin, Necattin First, Koray Das, Nazmi Ozer, Ahmet Seker, Yasin Kara, Mehmet A Bozkurt, Ali Kocataş, Semra D Atici, Murat Akalin, Bulent Calik, Elif Colak, Yuksel Altinel, Serhat Meric, Yunus E Aktimur, Serge Chooklin, Serhii Chuklin, Andriy Bilyak, Fernando Bonilla Cal, Lianet Sánchez, Fabiana Domínguez, Abdullah Meead, Ibrahim Al-Raimi, Haneen Alshargabi, Victoria Hudson, Jean-Luc Duval, Stavros Gourgiotis, Mansoor Khan, Ahmed Saad, Mandeep Kaur, Michael Wilson, Alison Bradley, Katherine Fox, Ivan Tomasi, Daniel Beasley, Alekhya K Prasanti, Pinky Kotecha, Husam Ebied, Fiammetta Soggiu, Michaela Paul, Hemant Sheth, Ioannis Gerogiannis, Mohannad Gaber, Zara Sheikh, Shatadru Seth, Maria Kunitsyna, Cosimo A Leo, Vittoria Bellato, Noman Zafar, Amr Elserafy, Giles Bond-Smith, Giovanni Tebala, Pawan Mathur, Izza Abid, Nnaemeka Chidumije, Pardip Sandhar, Syed OZ Ullah, Tamara Lezama, Muhammad H Anwaar, Conor Magee, Salma Ahmed, Brooke Davies, Jeyakumar Apollos, Kieran McCormack, Hasham Choudhary, Triantafyllos Doulias, Tamsin Morrison, Anna Palepa, Laura Álvarez Morán, Haydée Calvo García, Pilar Suárez Vega, Sergio Estevez, Mikel Prieto Calvo, Ibabe Villalabeitia, Fabio Ausania, Jordi Farguell, Carolina González-Abós, Santiago Sánchez-Cabús, Belén Martín, Víctor Molina, Luis Oms, Lucas Ilzarbe, Eva Pont Feijóo, Elena S Perra, Noel Rojas-Bonet, Rafael Penalba-Palmí, Susana Pérez-Bru, Jaume Tur-Martínez, Andrea Álvarez-Torrado, Marta Domingo-Gonzalez, Javier Tejedor-Tejada, Yaiza García del Alamo, Fernando Mendoza-Moreno, Francisca García-Moreno-Nisa, Belén Matías-García, Manuel Durán, Rafael Calleja-Lozano, José M Perez de Villar, Luis Sánchez-Guillén, Iban Caravaca, Daniel Triguero-Cánovas, Antonio C Maya Aparicio, Blas Durán Meléndez, Andrea Masiá Palacios, Aitor Landaluce-Olavarria, Mario De Francisco, Begoña Estraviz-Mateos, Felipe Alconchel, Tatiana Nicolás-López, Pablo Ramírez, Virginia D Muñoz-Cruzado, Felipe Pareja Ciuró, Eduardo Perea del Pozo, Sergio Olivares Pizarro, Vicente Herrera Cabrera, Jose Muros Bayo
Journal: JAMA Surgery (2023)

Importance Considering the lack of equipoise regarding the timing of cholecystectomy in patients with moderately severe and severe acute biliary pancreatitis (ABP), it is critical to assess this issue. Objective To assess the outcomes of early cholecystectomy (EC) in patients with moderately severe and severe ABP. Design, Settings, and Participants This cohort study retrospectively analyzed real-life data from the MANCTRA-1 (Compliance With Evidence-Based Clinical Guidelines in the Management of Acute Biliary Pancreatitis) data set, assessing 5304 consecutive patients hospitalized between January 1, 2019, and December 31, 2020, for ABP from 42 countries. A total of 3696 patients who were hospitalized for ABP and underwent cholecystectomy were included in the analysis; of these, 1202 underwent EC, defined as a cholecystectomy performed within 14 days of admission. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality and morbidity. Data analysis was performed from January to February 2023. Main Outcomes Mortality and morbidity after EC. Results Of the 3696 patients (mean [SD] age, 58.5 [17.8] years; 1907 [51.5%] female) included in the analysis, 1202 (32.5%) underwent EC and 2494 (67.5%) underwent delayed cholecystectomy (DC). Overall, EC presented an increased risk of postoperative mortality (1.4% vs 0.1%, P &amp;amp;lt; .001) and morbidity (7.7% vs 3.7%, P &amp;amp;lt; .001) compared with DC. On the multivariable analysis, moderately severe and severe ABP were associated with increased mortality (odds ratio [OR], 361.46; 95% CI, 2.28-57 212.31; P = .02) and morbidity (OR, 2.64; 95% CI, 1.35-5.19; P = .005). In patients with moderately severe and severe ABP (n = 108), EC was associated with an increased risk of mortality (16 [15.5%] vs 0 [0%], P &amp;amp;lt; .001), morbidity (30 [30.3%] vs 57 [5.5%], P &amp;amp;lt; .001), bile leakage (2 [2.4%] vs 4 [0.4%], P = .02), and infections (12 [14.6%] vs 4 [0.4%], P &amp;amp;lt; .001) compared with patients with mild ABP who underwent EC. In patients with moderately severe and severe ABP (n = 108), EC was associated with higher mortality (16 [15.5%] vs 2 [1.2%], P &amp;amp;lt; .001), morbidity (30 [30.3%] vs 17 [10.3%], P &amp;amp;lt; .001), and infections (12 [14.6%] vs 2 [1.3%], P &amp;amp;lt; .001) compared with patients with moderately severe and severe ABP who underwent DC. On the multivariable analysis, the patient’s age (OR, 1.12; 95% CI, 1.02-1.36; P = .03) and American Society of Anesthesiologists score (OR, 5.91; 95% CI, 1.06-32.78; P = .04) were associated with mortality; severe complications of ABP were associated with increased mortality (OR, 50.04; 95% CI, 2.37-1058.01; P = .01) and morbidity (OR, 33.64; 95% CI, 3.19-354.73; P = .003). Conclusions and Relevance This cohort study’s findings suggest that EC should be considered carefully in patients with moderately severe and severe ABP, as it was associated with increased postoperative mortality and morbidity. However, older and more fragile patients manifesting severe complications related to ABP should most likely not be considered for EC.